SUMMER TOENAIL WOES

by BROBSON LUTZ, M.D. My toes appreciate a good summer vacation. After I get a tan going, my toes and feet look better. In the summer I am not on my feet like during the school year,” says Betsy Kaye Byrd, a teacher at Holy Name of Jesus School. Summer treasures include bathing suits, snowballs and visible toes. Toes actually begin peeking out of their hibernaculum each spring just after daffodils sprout. The closed-toe shoes of winter morph into open-toed footwear, sandals and the bare feet of summer. “I hate how my toes look when I ease into the open toe in spring. They have been crammed into closed shoes all winter,” adds Byrd. Toes need fresh air and sunshine this time of year. But some toes are not so lucky. They are held hostage in sock-encased darkness and humidity while toes of other owners are ventilated. Toenails are thicker than fingernails for a reason. Fingers are for the sensitive stuff; toes do battle as the foot takes to the road. Both protect sensitive underlying tissue. Think of toenails as the roof of the toe: Real roofs range from slate to thatch. The toenail equivalent of slate has a youthful sheen. These are the toenails that young people such as Byrd allow out for summer play. Some people hide their toes for a reason. Thick, opaque, discolored, ugly thatch-like nails are the bane of a carefree summer. The most common cause of unsightly toenails is a chronic fungal infection. They thicken and can curve under. The most appropriately New Orleans toenail, curved into a crescent shape, almost touches the edge of one side with the edge of the other. Ground Zero for fungal toenail infections is hot, humid Louisiana. The medical term for a fungal infection of the toenails is onychomycosis. The reported nationwide prevalence of this cosmetic infection is only 2 percent to 4 percent, but among adults in the New Orleans area, the prevalence approaches 50 percent in some age groups. Summer 2004 turned into a toenail nightmare for one local writer who demanded anonymity before sharing her story. “The gift of a pedicure certificate at a popular day spa led to my first, and, I pray, last nail fungus. I tried to convince myself it was not all that disgusting. Then, after wearing fabulous Donald Pliner shoes to a convention, I lost both of my large toenails and was devastated.” “It was [last] June. It was a terrible experience. I had five pairs of shoes I could not even start wearing until this past Easter. “You can buy fake fingernails but no fake toenail. A Band-Aid around one toe can be passable. But a Band-Aid on two big toes looks insane. You can wear mules that are closed in the front and open in the back, but then you worry you are suffocating the toenail and stunting its growth. Espadrilles are the best solution. You just have to hope you lose your toenail in a year they are in style. “I know at least four other women who suffered the same trauma from spas and pedicure places. Everyone I know now owns their own tools and brings them to the spa to get a pedicure. I still have not been able to go back. I became a permanent do-your-own-pedicure girl,” concluded my secret source. Often fungal infections attributed to pedicures from nail salons are caused by improper clipping rather than from another person. The proper clip is short and straight across. If the nails are drastically rounded at the corners, skin breaks can occur, which can serve as portals of entry for the ubiquitous fungi that cause onychomycosis. Signs and symptoms First, the good news. The “look” may range from simply unsightly to hideous, but most fungal toenail infections are painless. Over time, a progressive fungal infections causes the nail to become opaque, thick, brittle and discolored. For most people, onychomycosis is simply a cosmetic infection. More severe infections can cause pain and discomfort. Persistent infection can also set the stage for other more serious infections for some persons, especially diabetics. There is a genetic predisposition or vulnerability to onychomycosis. If your parents and grandparents had the thick, discolored toenails that are symptomatic of fungal infections, you will, too. The most effective way to avoid fungal toenail infections is to keep your toenails well groomed, short and well aerated. Sandals are the best choice of footwear. They provide protection for the soles of the feet yet allow free circulation of air and light (see box). Jumping into summer sandals has at least one hazard. Tender toes exposed to new pressure points tend to rebel. Their rebellion turns into a blister. For years, people choosing fashionable sandals accepted blisters as the necessary hazing to break in their statement. This is no longer the situation. Fashionable yet foot-friendly sandals emanated from Rockport, the standard bearers of comfortable shoes. Most other sandal manufacturers took the hint. Treatment Onychomycosis may be a simple infection, but it can be very stubborn to treat because toenails grow so slowly. The first line of defense against being seen with unsightly toenails, at least for women, is toenail polish. Fortunately, nail polish does not predispose or worsen fungal infections. There are effective treatments, albeit drawn-out and expensive. Most treatments take at least three months to show best results, so if you are just starting now, forget about an instant cure for this summer. Doctors can prescribe safe prescription drugs for mild fungal infections, such as Penlac. After trimming off exposed portions of the infected nail, the transparent Penlac is painted on the affected nail daily like nail polish. Expect to shell out about $250 for the recommended 48-week course of treatment. The cost for prettier toenails with standard drugs does not come cheap. Most insurance companies do not cover these drugs when used to treat simple toenail infections. Bottom line, for the toenail fungus fighter with more sense than money – buy a $3.50 bottle of Vicks VapoRub and use it for six months before shelling out more than $900 for three months of Lamisil or Sporanox. •

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